Transitional Medicine
Articles - Are we losing the he(art) of medicine?
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Are we losing the he(art) of medicine?
by Kirsti A. Dyer, MD, MS
June 1997 Editorial Board Forum
I recently asked myself this question after trying to explain other physician's actions to a dear friend, a dentist, as she told me the agonizing details of her experience with the medical profession during and after the birth of her first child.

My friend had a long labor with ruptured membranes resulting an a beta-strep infection in her newborn. A physician authorized the child's release despite fever, delaying the diagnosis of streptococcal meningitis for several critical hours. The following morning, the child was not feeding, still febrile, and minimally responsive. Fortunately, my friend trusted her emerging maternal instincts and sought a hospital with a higher level of care, where the infant's meningitis was diagnosed and treated. Months later, another sequence of events led to a delay in diagnosing the resulting hydrocephalus and the need for placement of a ventricular-peritoneal shunt. The persistence of inexperienced parents, not necessarily the diligence of follow-up medical treatment, kept this child alive but not with residual learning deficits.    Her questions to me were poignant. "Why wouldn't anyone talk to me?" she asked. "Why didn't anyone take the time? We were never told he might develop hydrocephalus and what we needed to watch for." Her most disturbing statement was, "I spend more time deciding what material to use for someone's tooth filling than those doctors spent talking to me."

What could I say?

The doctor patient relationship is based on trust. The physician must be trusted to inform the patient of the diagnosis and treatment plan, and above all to "do not harm." How could I console my friend, who works daily with patients herself, and whose trust was shattered by fellow health care providers? How could I rationalize the behavior of other physicians, who had perhaps intentionally evaded questions about a "bad baby" outcome, because to discuss it might imply error? Could I restore her faith in the medical system? Should I?

We practice medicine in a time when physicians are pressured to see more patients in less time, while not missing any major medical or mental problems, all in 12.5 minutes.
 I further wondered how I could defend my profession when I, too, have found myself, when stressed or extremely fatigue, making minor errors of being perceived as distant, insensitive, and not informative. We practice medicine in a time when physicians are pressured to see more patients in less time, while not missing any major medical or mental problems, all in 12.5 minutes. I am aware of physicians who are penalized for over utilizing outpatient services, practicing, good preventative services, and subsequently under utilizing hospital admissions, or who are paid only half salary for working a full day of their quota of patients is not met. Under managed care, physicians can be financially penalized, for not "meeting productivity," if they spend an extra 15 minutes to ensure that patients are properly informed. Are we losing the heart in the practice of medicine?

During my internship, I succumbed to the effects of what I termed the "toxic intern syndrome." Like many of my colleagues, I was taught to be devoid of emotion. I realized that I had changed when a friend told me he would not want me as his physician. Since then, I have worked to hold on to my heart when physicians, residents, and staff around me were being abusive or insensitive. I resolved not to mirror these negative attributes and sought out positive role models. My goal during residency was to treat my patients with compassion and to emerged with my heart intact. These are not desirable skills under managed care, because it takes time to listen.

Would my friend's story have had a different outcome if any of the physicians involved had listened, checked all laboratory and X-ray reports earlier and remembered to educate these new parents on following a child after a serious neurologic injury? The answer, unfortunately, is obvious. If we, as a profession, lose the heart of medicine, the we will suffer an irreplaceable loss--the soul of medicine.   Maintaining a heart in the practice of medicine can at times be difficult, but for the sake of out hearts and our patients, it is something we must preserve.

Last updated July 11, 1998
Are we losing the he(art) of medicine? is copyrighted June 1997 by the California Physician and used with permission of the journal and the author.
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